How Can an 18 Year Old Lower His Hairline?

/by William Rassman, M.D./0 /,

Is there absolutely no way for an 18 year old to lower his hairline. I am a performing musician so my image is fairly important. Whether I am on the way to a fully bald head I don’t know but I have always had a very high hairline and thin curly hair which is really hard to manage and maintain. Messy hair just doesn’t look cool with a 4 inch forehead.

I do not know anything about you and certainly do not know what you look like. Yes, hairlines can be lowered a number of ways… but would I do it on an 18 year old that wants to look cool? Probably not.

If there is good reason to do it, I would consider it, but a doctor-patient relationship is critical and that starts out with a face to face meeting.

Tags: hairline, high hairline, teenager, teen

In the News – First Robotic Hair Transplant Performed

/by William Rassman, M.D./1 /

Snippet from the article:

A robotic arm, used to harvest hair from a person’s head, sounds strange but it’s the newest way to combat hair loss.

“I started losing my hair in my early 20’s,” said 38-year-old Vincent Delany. “It started receding back where I just had a little strip. Then my crown started thinning a lot where you can actually see scalp.”

It was a big enough concern that Delany looked into hair restoration surgery. He tried the traditional graft harvest, also known as the strip method. This is when a strip of skin is removed and doctors remove the follicular unit grafts one by one under a microscope. The method can be tedious and long.

Read the rest — Doctor Uses Robotic Arm To Perform Hair Transplant

This new technology will make follicular unit extraction (FUE) more popular and easier for most doctors, but it will not likely drive the cost of a hair transplant down as the robotic Artas® system is quite expensive for the clinic ($200,000 for the machine) plus the company charges an additional $1/graft.

This system extracts the grafts for the doctor and does so with minimal damage, but it still does not address the placement of graft, which is a technical limiting activity for many doctors wanting to enter the hair transplant business. The process of moving the grafts requires that they are taken from the “wet” environment they are placed in after harvesting (a dish or container of saline) and moved into the recipient area. This is a manual activity and requires skills that are acquired over years working in the field. There is a wide variation amongst doctors in delivering the placement of graft skill, so the robotic system must eventually deliver graft placement to close the loop for a complete robotic hair restoration.

Grafts can die if they are exposed to the air for as short a time as just 10 seconds, so keeping grafts moist is critical to graft survival (with or without the robot). For many doctors who have not mastered the FUE technique, this instrument can change the harvesting technique that is routinely offered; however, there is no experience with large sessions with the Artas® system (sessions above 1500 grafts) so more frequent surgeries may be necessary for those individuals who have Class 4-7 balding patterns. I have no doubt that the placement of grafts will eventually be included in a robotic hair restoration process and look forward to the day that it is available.

There’s a photo of the system here and in full disclosure, Restoration Robotics (the maker of this system) licensed the core optical technology from us.

Tags: restoration robotics, artas®, hair transplant, fue, robot, robotic

After 13 Years on Propecia, Could I Be Developing a Facial Rash From It?

/by William Rassman, M.D./0 /

Hi, I am 43 year old and been taking propecia 1 mg per day and 5 % minoxidil. I have taken these for the last 13 years. The results have been amazing, probably a little less hair on top and sides now. As far as I am aware you didn’t/don’t think I have had any side effects. Well I have a slight none itchy rash above my upper lip. I have got very worried about using the propecia so I want to give this drug up. How would I scale down the drug and over what time period please. I have already halved the tablet each day. I do hope you can help, there is just so much worrying data on net saying about terrible side effects after finishing off propecia. Thanks in advance

The dosage of any medication has little to do with the allergic response. If you are allergic to it, cutting the finasteride pills in half will not solve your allergy issue. It’s possible that either Propecia or minoxidil could cause allergic reactions like you described, but you could and probably should see a good doctor for the discussion.

Stopping the pills or the minoxidil for a couple of weeks will have minimal impact on the hair, but will address the allergy issue if that is the cause.

Tags: minoxidil, propecia, rash, facial rash, hairloss, hair loss

Bald Spot Removed with Expander, Now 15 Years Later the Hair Is Thinning There

/by William Rassman, M.D./0 /

I fell against an open fire surround when a child. I suffered a bald area 3 inches wide by 2 inches long. 15 years ago I had an expander inserted and about 90 percent of the bald spot was removed. This was okay but now my hair is thinning around the scar area.

I am female over 55 and am very conscious of this as I am very limited in my hairstyles. As the thinning area would hopefully now have enough blood supply from the ajoining hair, would I be able to have transplants inserted into the thinning area?

Also, how do I find a good surgeon in the Northern Ireland area. Thanks

Each case is unique, so there’s no way I could know if you’re a candidate for transplantation without an examination. I could evaluate you, but from Ireland it would be difficult. Look to the ISHRS for doctor recommendations in Ireland.

Dr. Bessam Farjo is one a contributor to this site and is based in the UK, so it may be worth a trip to have him evaluate you.

Tags: hair transplant, balloon expander, hairloss, hair loss

Why Would a Doctor Transplant a 20 Year Old?

/by William Rassman, M.D./0 /

Here is a link to the patient photo section of Dr Ziering’s Hair Transplant website. In the UK, Dr Ziering is perhaps the most well known hair transplant surgeon because of his celebrity clients and working with ‘The Hospital Group’; the market leader of cosmetic surgery chains.

One of his patient is a 20 year old man who received 1700 grafts. Normally, hair transplant surgery on someone so young would set my alarm bells ringing. However, because Dr Ziering is well respected and working in partnership with a huge, national company, I trust he made the right decision in transplanting this young man’s hair.

Based on the before and after pictures of this patient, would you have offered him a hair transplant and if not, why not? If it’s hard to tell without seeing the patient in person, could you shed light on circumstances which might mean someone so young could be considered a good candidate?

If it helps contextualise this message, I am 20 years old and was planning on using Propecia and Rogaine until I’m old enough for surgery-but this picture is making me question that decision.

Here’s a direct link to the patient you’re referencing (the description says the patient is 20 years old and the after photo was taken 9 months post) — here.

The before picture does show significant frontal balding worthy of a hair transplant under the right circumstances. The maturity of the patient and his ability to understand a Master Plan for his hair loss is a concern. Many young men might reverse on Propecia and in these pictures, the reversal of all (or a significant part) of his hair loss with drugs alone would certainly reduce the amount of surgery necessary. He might not have even needed surgery, depending on the result after taking the drug. I don’t have any history on this patient, so I don’t know the full course of action that his doctor recommended.

So not knowing anything about the patient besides his age, I would not transplant the top of the scalp where the thinning is obvious, as this area often reverses on Propecia alone. But if I knew this patient and could assess his maturity and financial plans for the future, I might very well have transplanted him, despite his young age. Each case is unique and should be evaluated as such.

Tags: hair transplant, hairloss, hair loss, age

After 3 Months on Finasteride, I Saw Hairline Growth — Then I Started Shedding All Over My Scalp

/by William Rassman, M.D./0 /,

I have been taking generic finasteride for almost 5 months. The first 2 months I didn’t see much of anything then almost on que at the beginning of the third month hairs began to sprout throughout my hairline and continued to grow throughout the month. Then again almost exactly at the beginning of the fourth month i started to feel as though i was starting to shed throughout my entire head. The shed has continued as i am approaching 5 months. Is this a good or bad sign?

I can not tell you that this is good or bad, since I really do not understand it. If I measured your hair bulk and mapped your miniaturization prior to starting the finasteride, I might be able to give you an idea on what was happening. Did you get such baselines? Regrowth at the hairline is quite rare to begin with, but diffuse shedding after 4 months of taking it is unusual.

Finasteride is a prescription medication, so I’d book an appointment with your prescribing doctor immediately and try to get to the bottom of what is happening.

Tags: hairloss, hair loss, finasteride, hairline growth

Taking Larger Dutasteride Dosage Once a Week

/by William Rassman, M.D./1 /

I understand that you don’t prescribe Dutasteride and that taking it is something one should carefully consider. However, I was wondering if you could answer a question about the half life of the medication. I have read that the half life of Avodart is 5-6 weeks and this got me thinking; if you were to take 3.5mg once a week as opposed to 0.5mg daily, would there be more dutasteride in your system and thus more chance of maximizing its benefits and having side effects? Or, would both dosage methods amount to the same thing?

I do not prescribe it because it is not FDA approved for treating hair loss, there are more sexual side effects with this medication, and the sterility reports are more numerous and maybe irreversible when it happens.

With the long half life, less frequent dosing should be adequate, but there is no dosing information available to guide the doctor on how to prescribe it for treating hair loss. So while it might sound logical to take a larger dose once a week, I don’t know how that plays into side effect risks or safety.

Tags: dutasteride, hairloss, hair loss, avodart

Rash and Swollen Face After Using Minoxidil 5%

/by William Rassman, M.D./0 /,

I have been put on minoxidil 5% a week ago. Broke out with rash and now my whole face is swollen and I have a lymphanode at the back of my head that popped out. Prior to this I had been using minoxidil 2%. l am a 34 year old female.

You should see a doctor. You could have had a reaction to the higher strength drug and may have to stop it. This is a known severe allergic reaction of minoxidil (see here for more).

Tags: minoxidil, rogaine, rash, swollen face

In the News – Going Gray is Common After a Hair Transplant?

/by William Rassman, M.D./0 /,

Snippet from the article:

The clinic who treated Wayne Rooney when he had his hair transplant have admitted that developing grey hair can be a common short-term side-effect of the procedure. The Manchester United and England star reportedly spent £30,000 to get a full head of hair earlier this year in a bid to cure his baldness.

However, while it appears to have reversed his receding hairline, the footballer’s new thatch appeared to be slightly discoloured when he took to the field for Manchester United this weekend.

Wayne RooneyRead the rest — Wayne Rooney’s doctors say going grey is common side-effect of his £30,000 hair transplant

Graying often starts on the sides and sometimes the back of the head, so I would not be surprised to see it turn up in the transplanted area before the surrounding hair, because the source hair could often gray sooner. Since his sideburns and the back of the head are also gray, I suspect that the transplant had little to do with the color change.

This man is only 25 years old, so there’s probably some early genetic graying since it’s showing up in the non-transplanted region. Maybe he was dyeing it before the transplant and stopped following his surgery. I really don’t know.

Regarding graying be a common side effect — I have not seen my patients experience this temporary graying after a hair transplant that the doctor in the article talks about. Transplanted hair will grow and gray just like the rest of your hair.

Tags: wayne rooney, hair transplant, gray hair, grey hair, surgery

Finasteride Stopped Working and My Doctor is Too Busy To See Me

/by William Rassman, M.D./2 /,

Good Afternoon!
My doctor prescribed Propecia 1 mg per day, 3mg per day of Biotin Forte and wash my hair 3 times a week with Ketoconazole shampoo in 11-6-03, follow up was one yr later 04. I started generic Finasteride 5 mg to save $ 6 months ago. I break the tablets, everything was great until June of 2011. I have had recent rapid hair loss on the crown & back of head.

My doctor is too busy, takes months to get appt. Any referrals? Suggestions maybe closer to AZ? No side effects except I have a sore left Testicle for about 3 yrs now, my doc cant figure out why its sore? Im now 51. Thx!

I think that if your doctor does not have the time for you, you need to find a doctor who does. I don’t have a referral for you in Arizona, but you can check out the physician search at ISHRS.org.

As for the recent hair loss starting after switching from name brand Propecia to generic finasteride — I really don’t know. It should be the same medication, just different doses. Are you breaking the 5mg tablets into 4 equal parts? Did you get the generic from a legit pharmacy? What was the maker of the generic? Have you talked to your pharmacist about perhaps trying a different generic brand?

Tags: propecia, finasteride, hairloss, hair loss

My Hair Transplant Hasn’t Grown In 3 Months After Surgery

/by William Rassman, M.D./1 /,

Dear Doctor R.,
I had a FUT procedure of 3,000 grafts 3 months ago, primarily into the vertex area. Three months on, none of the transplanted hair has yet fallen out nor has it noticeably grown past 5mm.

Should I understand this as a random event, or should I infer that this represents some indicator of the expected telegen/anagen phase timeline? Thanks & with regards

I would not expect the hair to grow out until 5-7 months have elapsed. Following a hair transplant, your newly transplanted grafts will go through a dormant phase. All you can do at this point is have patience. Some people could see the start of growth after a few months, some take a little longer. A very lucky few will not go through any dormant phase and the hair just starts growing.

Did you ask your surgeon? You should’ve been informed of the wait time prior to undergoing your surgery.

Tags: hair transplant, hairloss, hair loss, hair growth

I Was Born With Little Hair and Feel Cheated

/by William Rassman, M.D./0 /

I am a 57 year old female. I have five sisters and five brothers. All were born with full heads of hair. Both my father and mother had a lot of hair. Especially my mother. For some reason I was born with little hair. I always felt I was cheated. I started wearing a hair piece at 22yrs. What would have caused me in my mothers womb not to have had as much hair as my siblings. Thank you

There are genetic conditions that are present that give very little hair to a normal scalp. You need to be evaluated. Genetic testing (probably expensive) might be a place to look, but first a good examination by a competent doctor should be where you start.

Tags: hairloss, hair loss, female hair loss

I Think My Sperm Count is Lower After Using Propecia for 5 Weeks

/by William Rassman, M.D./0 /

It has been 5 weeks since i started propecia, i think my sperm count and density as well might have decreased a bit, should i keep on using the medication? No loss of libido though.

A known side effect of finasteride (Propecia) is a reduced volume of ejaculate and this occurs in somewhere between 10-20% of patients, but all of these men will have a normal sperm count when tested for their actual count. You may be confusing ejaculate volume (which is often lower when taking the drug) to sperm count (usually range is in the 15-60 million per cc). There is more to sperm being present that is important. One looks at the health of the sperm (morphology), the motility of it, the sugar (fructose) in the fluid, etc.

If you want to know if you have azoospermia (no sperm in the semen) then you can get your doctor to recommend that you be tested. There are some rare reports and concerns that finasteride can reduce the actual sperm count and even produce sterility if the azoospermic counts go down to very low numbers. When this happens, the process often reverses when you stop taking finasteride.

Tags: azoospermia, sperm, semen, finasteride, propecia

NBA Player Deron Williams’ Hair Loss

/by William Rassman, M.D./0 /

Dr. Rassman, first off I love this blog and it is really informative. I just had a question about the NBA player Deron Williams. In 2008 his hair looked really thin and now if you search on in 2011 or with Nets his hair seems to have drastically improved. What do you think he did?

I used Google Image Search to find some photos that highlighted the difference in Deron Williams’ hair over the past few years. Here they are:

Deron Williams

Usually photos will show what the photographer wants to show. There could have been Propecia used over the years to see regrowth, or it could just be hair styling, a camouflaging agent (Toppik / DermMatch), more flattering lighting in the 2011 photo I found, or even just letting his hair get a little more length. If I had to guess just based on a couple photos, it looks like it could be a combination of styling and something like Toppik… but I really have no way to know that for sure. I couldn’t find anywhere that Mr. Williams himself mentioned if he did anything with his hair.

Sources: 2008 photo, 2011 photo

Tags: nba, basketball, athlete, deron williams, hairloss, hair loss